EPIDEMIOLOGI CEDERA

(Injury Control: the public health approach)

Yunus Ariyanto
2007
 Tujuan Pembelajaran
• Riwayat analisa epidemiologi cedera
• Model kausa cedera
• Data kecelakaan: mortalitas, morbiditas, dan
klasifikasi kecelakaan
• Cedera ditinjau dari aspek epidemiologi
• Strategi pengendalian cedera
 Riwayat analisa epidemiologi
• Meskipun cedera/kecelakaan sudah dipastikan
sebagai pembunuh sejak sejarah manusia
namun penelitian secara sistematis baru
dilakukan pada abad 20
 Riwayat analisa epidemiologi
• “the effectiveness of an injury prevention
strategy demonstrated that helmets
decreased head injuries among motorcycle
riders in the military (Cairns 1941; Cairns and
Holbourn 1943)”
• Penelitian epidemiologi awal:
membandingkan kelompok yang memakai
helm dengan yang tidak
 Riwayat analisa epidemiologi
• “injury patterns by age, gender, and other
demographic factors (John Gordon 1949)”
• Menegaskan: cedera/kecelakaan bisa dianalisa
dengan metode epidemiologi yang umumnya
dilakukan untuk menganalisa penyakit
 Riwayat analisa epidemiologi
• “energy and its many forms as the agent of
injury (James Gibson 1961)”
• “framework for injury causation based on the
infectious disease model (Haddon 1963;
Haddon et al. 1964)”
• Menyusun model kausa cedera/kecelakaan
berdasar konsep segitiga epidemiologi
 Riwayat analisa epidemiologi
• Hugh DeHaven survived a crash of his trainer
aircraft and noticed that his abdominal
injuries were related to the shape and riveting
location of his safety belt.
• “vehicle engineering could reduce the severity
of injuries during crashes (DeHaven 1968)”
• Awal kombinasi keahlian teknik dan
epidemiologi
 Riwayat analisa epidemiologi
• “the first documented computerized trauma
surveillance system was introduced in 1969 at
Cook County Hospital in Chicago (Pollock and
McClain 1989)”
• Sistem surveilans cedera/kecelakaan pertama
yang bersifat lokal
 Model kausa cedera
Environment
No injury

Reservoir

Agent, host and

Vehicle
evironment factors

Agent Host Injury

Vector
 Model kausa cedera
• The agent, which in the case of injuries is
energy, is absorbed by the host to cause
injury. Energy can take many forms, such as
mechanical, electrical, chemical, radiation,
and thermal. An example of an agent–host
relationship is a motor vehicle crash, in which
the energy exerted on the individual is
mechanical.
 Model kausa cedera
• The reservoir is the place in the environment
where the agent is found. The potential for
energy transfer exists everywhere, but its
ability to cause injury is limited. For instance,
the potential energy in a bullet causes injury
only when the bullet is in motion and hits a
human.
 Model kausa cedera
• Vehicles and vectors are mechanisms which
transport energy from the reservoir to the
host. A vehicle is an inanimate object, such as
a motor vehicle; a vector is animate, such as
the dog that bites a child. For many injury
causes, vehicles and vectors are both involved
in energy transfer, such as when one
individual (vector) stabs another with a knife
(vehicle).
 Model kausa cedera
• The injury outcome is the trauma or injury
sustained by the individual, and is influenced by
host responses to the energy. Only energy
transmitted beyond a host's tolerance causes an
injury, and therefore not all exposures to energy
result in noticeable injury. A human has some
resistance to energy which can be increased
through exercise or protective devices, or
reduced through changes in intrinsic factors such
as existing medical conditions or age, or through
extrinsic factors such as fatigue and alcohol.
 Definisi Kecelakaan
• “an accident is an undesired and unpleasant
suddenly occuring event with human and
economic losses caused by uncontrolled
disturbances in the interaction of component
in system” (Setijowarno dan Frazilla, 2003)
 Aspek epidemiologi
• In 1997, unintentional injuries were the fifth leading
cause of death in the United States, following heart
disease, cancer, stroke, and pulmonary diseases.
Suicide and homicide were the ninth and thirteenth
leading causes respectively. However, unintentional
injuries were the leading cause of death for those aged
1 to 44 years.
• Homicide was among the three leading causes of death
for those aged 1 to 34 years, and suicide for the ages of
10 to 34 years. The three leading causes of death for
those aged 15 to 24 years were unintentional injuries,
homicide, and suicide (Hoyert et al. 1999).
 Aspek epidemiologi
• Non-motor-vehicle unintentional injuries are
the leading cause of injury death from birth to
age 5 and again after age 35, although the
causes of these deaths differ. Alcohol use is
an important risk factor in motor vehicle
crashes for all ages, but is a particular concern
among drivers under 25. The elderly also have
high pedestrian injury death rates.
 Aspek epidemiologi
• Death rates for injuries also vary by racial
group. In 1995, Native Americans had the
highest unintentional injury death rate and
the highest suicide rate (Fingerhut andWarner
1997). African-Americans had the highest
homicide rate, which was 123 percent higher
than the rate for Hispanics, who had the
second-highest rate. Asian-Americans had the
lowest death rates for both intentional and
unintentional injury.
 Aspek epidemiologi
• The average annual prevalence of physical
impairments due to injuries in the United
States in 1985 to 1987 was almost 19 million,
or 80 per 1000 persons (National Center for
Health Statistics 1991).
 Aspek epidemiologi
• Individuals with moderately severe motor
vehicle crash injuries had an average of 6.5
years of resulting impairment and 2.7 years of
lost productivity (National Center for Health
Statistics 1991).
 Aspek epidemiologi
• The years of productive life lost from injuries
exceeds all other life-threatening conditions (Rice
et al. 1989).
• Although unintentional injuries are the fifth
leading cause of death in the United States, they
were the third leading cause of potential life lost
in 1995 with 2.5 million years lost. When
including suicide and homicide, the years of
potential life lost to injuries exceeded 4.3 million
(National Safety Council 1998).
 Aspek epidemiologi
• Studi Dephub-JICA tahun 2002, sejak th 1982 -2000
terjadi 3.826 kejadian kecelakaan kapal atau rata-rata
204/tahun, atau terjadi kecelakaan setiap dua hari
sekali.
• Meskipun demikian statistik kecelakaan kapal
menunjukkan bahwa rata2 kecelakaan kapal pada
tahun 1998, 1999 dan tahun 2000 menunjukkan
kecenderungan menurun, menjadi 64 kejadian per
tahun, atau satu kejadian setiap lima hari sekali.
(Sumber : Dephub-JICA, The Study for The Maritime
Traffic Safety Development Plan in The Republic of
Indonesia, 2002)
 Aspek epidemiologi
• Dewan Maritim Indonesia (DMI) memastikan 72% dari
kasus kecelakaan laut di Indonesia adalah HUMAN
ERROR, mencapai 26 kasus selama semester I/2005
• 5 pihak yang memberi kontribusi secara langsung
maupun tidak langsung memberi Kontribusi terjadinya
kecelakaan laut di Indonesia , yakni : Anak buah kapal
(ABK) dan nahkoda 80,9%, Pemilik kapal (shipowner)
8,7%, Syahbandar 1,8%, Biro klasifikasi 3,1%, Pandu
5,5%
(Hasil penelitian independen International Maritim
Organization (IMO)di Indonesia Th 1990-2001)
 Aspek epidemiologi
• Kelompok Umur %
• 16 – 20 19,41
• 21 – 25 21,98
• 26 – 30 14,60
• 31 – 35 09,25
• 36 – 40 07,65
• 41 -75 18,91
Sumber : Direktorat Jendral Perhubungan Darat
 Aspek epidemiologi
• Tingkat kecelakaan darat di Indonesia yang
cukup tinggi dan menyebabkan korban
meninggal hingga 30 ribu orang/tahun, saat
ini telah menjadikannya sebagai “pembunuh”
nomor tiga. Angka kematian akibat kecelakaan
sudah mencapai 75 ribu orang dan luka sekitar
5 juta orang per tahun. Hal ini dinilai
menghilangkan potensi ekonomi sekitar 15
milliar dolar AS
 Aspek epidemiologi
• Dalam kurun waktu 1995 - 2000, santunan
yang yang dibayarkan sebesar Rp 674 milyar,
atau rata-rata setiap tahun PT Jasa Raharja
membayarkan lebih dari Rp 155 milyar
 Aspek epidemiologi
• Kasus kecelakaan KA:
• Th 2000 (126), Meninggal (98), Luka berat
(91), Luka Ringan (63)
• Th 2001 (132), Meninggal (140), Luka berat
(179), Luka Ringan (105)
• Th 2002 (217), Meninggal (63), Luka berat
(105), Luka Ringan (62)
 Strategi pengendalian
• The main objectives of injury research are to
prevent the occurrence of injuries and to
reduce their level of severity. Limiting
prevention strategies to any single aspect of
the many causes of injuries is an ineffective
and narrow approach (Association for the
Advancement of Automotive Medicine 1993).
 Strategi pengendalian
• Unlike many chronic diseases, the agent and
time of injury onset is almost always known
and can be measured, and the mechanism of
energy transfer from reservoir to host can be
described.
• With several exceptions, injuries usually occur
immediately after exposure and rarely have
the long incubation or latent periods of many
infectious and chronic conditions.
 Strategi pengendalian
• The Haddon Matrix, a model of the agent–
host relationship in injury causation, was the
foundation for the study of motor vehicle
crashes and countermeasures for highway
safety, and continues to be an applicable
theoretical framework for injury prevention
(Haddon 1963, 1972).
 Strategi pengendalian
• The Haddon Matrix divides the timing of the injury event into three
phases: pre-event, event, and postevent. These phases correspond
to the three levels of prevention defined by public health.
• Primary prevention, which occurs during the pre-event phase,
prevents the injury event by eliminating the mechanisms of energy
transfer or exposure. Traffic safety laws or vehicle modifications
which prevent automobile crashes, fences around swimming pools
which prevent submersion, trigger locks on guns, and safety caps on
poisonous substances are all examples of primary prevention which
reduce or eliminate the chance of exposure.
• The goal of secondary prevention, which occurs during the injury
phase, is to eliminate or reduce injury severity once an energy
transfer has occurred. Motorcycle helmets, seatbelts, life vests, and
bulletproof vests are examples of secondary prevention. While they
do not prevent the event which causes injury, they do reduce the
energy absorbed by the host.
 Strategi pengendalian
• It is important to note that some of the most
effective secondary prevention strategies do
not eliminate all injuries.
• For example, the motorcycle helmet is very
effective in reducing head trauma in
motorcycle crashes, but is not effective in
preventing trauma to other body regions
(Kraus et al. 1994).
 Strategi pengendalian
• Tertiary prevention, which occurs in the
postinjury phase, aims to reduce the
consequences of the injury once an injury-
producing energy transfer has occurred.
• Emergency and trauma care, as well as
rehabilitation efforts, are examples of tertiary
prevention. Some of the most important
advances in injury control have been
improvements in the early response and
treatment of serious injury.
 Strategi pengendalian
• Specific injury-prevention strategies can be
divided into two very broad groups based on
need for host actions.
• Passive intervention requires no input or action
by the host and is usually accomplished by
modifying the agent, vehicle, vector, or
environment. Modifications in car design to
improve brakes and increase the energy absorbed
by vehicle components are two examples.
 Strategi pengendalian
• Active intervention requires that the host take
some type of action for the intervention to
work. Seatbelts and helmets are examples of
active intervention.
 Strategi pengendalian
• Just as effective injury-control strategies must
address multiple facets of injury occurrence,
they should also incorporate active and
passive intervention strategies to be fully
effective. Passive intervention strategies are
usually considered more effective, especially
when compared with active interventions
which require frequent or time-consuming
action (Waller 1985).
 Strategi pengendalian
• Air bags, for example, require no driver action,
whereas seatbelts can only be effective when
fastened by the occupant. However, the most
effective crash protection occurs when both
are available.
Elemen kecelakaan
Pencegahan kecelakaan